Trump’s Nominee for VA Secretary, Dr. David Shulkin, Discusses Veteran’s Health Care

Dr. David Shulkin – Chief Executive of the Veterans Administration

(Music)

Mark Masselli: This is Conversations on Healthcare, I am Mark Masselli.

Margaret Flinter: And I am Margaret Flinter.

Mark Masselli: Well Margaret , President - elect Trump held his first press conference at
Trump Towers in New York . He stuck to his guns on the promise to repeal and replace
the healthcare law simultaneously Trump saying that it will be done as soon as a plan
can be devised to replace the complex healthcare law .

Margaret Flinter: Trump also used the forum to announce his choice for a Secretary of
the Veterans Administration Mark , Dr. David Shulkin was hand - picked by President
Obama to revamp the Veterans Health Administration which has been plagued by
controversy in the past few years due to long wait times at many VA facilities around the
country . This VA sandal led to a lot of scrutiny in how best to improve the system that’s
not an easy lift but Dr. David Shulkin has a solid reputation for turning health systems
around and we wish him well on that.

Mark Masselli: We certainl y do and we might ha ve been little prescient by having him
on just a few months ago , he brings extensive expertise from the private sector , we
thought it would be a good idea to revisit our interview with him .

Margaret Flinter: And Lori Robertson will ch eck in, the Managing Editor of
FactCheck.org, she is always on the hunt for misstatements spoken about health policy
in the public domain.

Mark Masselli: But no matter what the topic, you can hear all of our shows by going to
chcradio.com. And as always if you have comments , please email us at
[email protected] or find us on Facebook or Twitter; we love hearing from you.
Margaret Flinter: We will get to our interview with Dr. David Shulkin in just a moment.
Mark Masselli: But first here is our producer Marianne O'Hare with this week's headline
news.

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Marianne O'Hare: I am Marianne O'Hare with these Healthcare Headlines . In his first
news conference in six months President - elect Donald Trump made good on his

Dr. David Shulkin – Chief Executive of the Veterans Administration

promise to repeal and replace the Affordable Care Act , the Senate followed suit in a
late - night session came to a vote 51 to 48 moving ahead with repeal of the healthcare
law .

Pres ident - elect Trump also ma de it pretty clear he would be going after pharmaceutical
companies for high prices especially those with manufacturing plants in China and India
saying the companies are getting away with murder his comments and send some
pharmaceutical stocks tumbling in the wake of his pronouncements . The
pharm aceutical industry lost roughly $24 billion in value within minutes of the President -
elect's claims , analysts aren't certain exactly how the Trump administration will clamp
down on such companies .

President - elect Trump also use d a public forum to announce he would offer the position
of Secretary of the Veterans Administration to Dr. David Shulkin currently the
undersecretary for Veterans Health at the VA who had been selected previously by the
Obama White House to fix the problems of long wait times and po or care at VA
facilities , Shulkin is new to the VA with a celebrated career in the private sector . Trump
had offered the job to Cleveland Clinic CEO, Toby Cosgrove , who turned it down . The
Tru mp team also interviewed current director of the National Inst itutes of Health Dr.
Francis Collins to potentially keep the post he has held for the past eight years , Collins
who led the team that map ped the human genome and has been critical of
congressional budget cuts to the agency has expressed an interest to stay on in the
post. Maryland Congressman Andy Hardy has also expressed interest in a position ,
Harris is an obstetric anesthesiologist who has advocated for a more high risk high
reward approach at the NIH to accelerate the pace of research . He ha s also bee n
taking suggestions from organizations such as FasterCures at part of the Milken
Institute and Research America . FasterCures was instrumental in the passage of the
21st Century Cures Act which passed with bipartisan support at the end of last year
securi ng billions of dollars for biomedical research including for the Cancer Moonshot
that launched in the Obama administration and run by VP Joe Biden .

And take to Sun Salutations and Call Me in the Morning in a series of randomized
clinical trials yoga seems to have a moderate effect o n alleviating chronic low back pain
in long - term sufferers . The data were culled from about a dozen studies around the
world which compare those who did no exercise at all versus those who did yoga or
yoga with a little bit of other exercise . Those practicing yoga showed modest
improvement in their chronic pain , while there is not an abundance of data and more
studies are needed the results lead to a possible nondrug interventions for some
suffering from chronic pain an issue t hat impacts millions of people around the globe .
I am Marianne O'Hare with these healthcare headlines.

Dr. David Shulkin – Chief Executive of the Veterans Administration

(Music)

Mark Masselli: We are speaking today with the Hon. Dr. David Shulkin Under s ec retary
of Health at the US Department of Veterans Affairs as Ch ief Executive Officer of
Veterans Health Administration serving the health needs of almost 9 million US
veterans . Dr. Shulkin is the former President and CEO of Beth Israel Medical Center in
New York City and served as Chief Medical Officer at the Univers ity of Pennsylvania
Health System and the Medical College of Pennsylvania Hospital . A board - certified
internist , Dr. Shulkin is a fellow of the American College of Physicians and has been
named one of the 50 most influential physician executives in health care . He received
his medical degree from the Medical College of Pennsylvania completed his internship
at Yale University School of Medicine and his residency at the University of Pittsburgh .
Dr. Shulkin, welcome to Conversations on Healthcare.

Dr. Davi d Shulkin: Thank you , glad to be here.

Mark Masselli: Came in from the private sector to help the VA tackle some very serious
administrative problems . But the VA also serves admirably 9 million American veterans
at 1700 care sites , I wonder if you coul d share with our listeners the sort of scope and
complexity of the challenges you face .

Dr. David Shulkin: I don’t think most people realize this is the largest healthcare system
in the country so we are the largest employer of doctors , nurses just to gi ve you a size ,
we are the only healthcare system that is responsible for delivering care in every nook
and cranny of this country wherever a veteran lives even if we don't have VA facilities
there. So we work closely with the community providers and do wh at it takes to be able
to provide the veterans of this country the health care that they deserve .

Margaret Flinter: Dr. Shulkin, I know a whistleblower called detention to the problem of
the long wait lines in 2014 and the VA really respond ed strongly to this long wait time
issue with the program called Veterans Choice. But that program had a whole new set
of administrative issues and challenges , help us understand the intent of Veterans
Choice and the challenges you encountered and how is that faring no w ?

Dr. David Shulkin: Well first of all, I do have to say that what we now call the wait time
crisis was a significant challenge to the VA healthcare system , I of course came at the
president's request after the crisis to bring my private sector experien ce to the VA .
Congress actually gave us the Choice Program but you have to remember that the VA
has for years and years provided about 20% of its care in the community already to
supplement the VA healthcare system , and the Choice Program was supplemental
funding to be able to do this . The Choice program was filled with administrative
complexity and the VA healthcare system had 90 days from the passage of the Choice
Program to implement a nationwide new program . And I think that we all know now in
retros pect that a program of this size and scope probably needed to take longer than 90
days . But we have worked through many of those problems as we ha ve increased our

Dr. David Shulkin – Chief Executive of the Veterans Administration

authorizations of care in the community over fourfold in the past year but it still is a
pro gram that's far too complex and too burdensome . So we ha ve asked Congress to
make major changes in the program so it works better for veterans in that legislation is
pending for congressional vote .

Mark Masselli: You know speaking of complexities , veter ans face a whole host of
medical issues that are unique to their service perhaps one of the most pervasive is
posttraumatic stress disorder . And I think an estimated 20% of veterans face lingering
effects of PTSD and other mental health issues and it's es timated that 20 veterans are
committing suicide every day . And I wonder if you could talk to us a little bit about the
VA's targeted effort in addressing the crisis .

Dr. David Shulkin: It's just horrific number unacceptable and really one of our areas o f
top focus to address this , when you look into that number and there are 20 veterans a
day taking their life , only six of them are getting care within the VA healthcare system ,
that means there are the 14 a day who are out there potentially disconnected f rom the
best resources that can help them . One of the things that we are doing very diligently is
reaching out to as many community organizations as we can , churches and other
groups and friends and family of veterans and making sure that they know that i f they
see a veteran that is potentially in crisis to make sure that they are utilizing the
resources that are available in the VA particularly our Veterans Crisis Line which is
open 24 hours a day 365 days a year . We have over 300 suicide prevention
coor dinators who do nothing every day but work to address this issue . We are
implementing a research tool that actually uses our data to analytically predict those at
highest risk for suicide and proactively reaching out to those veterans and making sure
that we can offer them help and assistance . And it is such a critical issue not only for
veterans but really for all Americans where the crisis and suicide really has reached
what I will call epidemic levels .

Margaret Flinter: Let me ask you first related t o mental health but also an independent
risk factor is the problem of homelessness among our veteran population , and I think
the stat on this is in 2014 which is a couple years ago now there are an estimated
50,000 homeless veterans across the country . An d yet, just in the past year even I
have heard some reports of significant progress in some states including our own about
particularly targeting homeless vets. T ell u s about the program that VA and states
across the country have to try and mitigate this problem .

Dr. David Shulkin: One of the unique things about the VA healthcare system is that it
not only focuses on the physical health issues of our veterans but it actually focuses on
the social issues , the psychological issues and the economic issues . And as a
physician , you can't really address a person's health and well - being if they don't have a
home , and so VA has really focused on this . And over the last four years we have
reduced veteran homelessness across the country by 46% and that means that we
have housed hundreds of thousands of veterans and their families . But as you know
the issue of homelessness is a chronic problem in fact we were just with a group of
veterans recently in the south that were homeless and all them actually had jobs but at

Dr. David Shulkin – Chief Executive of the Veterans Administration

minimum wage they weren't able to afford housing.

We are working with the Housing and Urban Development federal officials, we are
working with local builders and real estate landlords to try to find affordable housing for
those that need it , a nd certai nly our goal is to end veteran homelessness . States like
Connecticut that you are mentioning have really done a terrific job in putting together
state local and federal resources to be able to actually end homelessness among
veterans.

Mark Masselli: We are speaking today with the Hon. Dr. David Shulkin Unde rs ecretary
of Health at the US Veterans Affairs Department, and the Chief Executive of the
Veterans Health Administration. Dr. Shulkin leads the nation's largest integrated
healthcare system serving t he 9 million US veterans . Dr. Shulkin you have a national
reputation in transforming healthcare and y et you took a 90% pay cut to join the VA so it
was really obviously about service . But I would love to hear from you of what motivated
you to take on the challenges and what are the building blocks for success as you think
about moving a very large ship in a different direction ?

Dr. David Shulkin: I would like to think that I am no different than any other American as
I was watching now over two and half years ago the wait time issues play out over
national TV and newspapers . I was as outraged as most Americans , what I didn't
realize is that in a few weeks I would be getting a phone call from the White House
asking whether I would be willing to step up a nd be part of the solution to help fix it .
How can you say no ? So I left my position and here I am , and I hope that all my
experience that I ha ve brought to the table is helpful in transforming the VA in the way
that you described .

Margaret Flinter: We ll Dr. Shulkin , you have also spent time in your career teaching
and I am not sure that many people outside of healthcare know that the VA is actually
the largest organization training health profession students . Talk with us a little bit
about the scope of health professions training in the VA .

Dr. David Shulkin: Yeah. One of the questions I hear quite frequently is , why do we
need the VA system , why not just give out a voucher system ? And people may not
realize the other things that the VA healthcare system does for the country , we train
over 120,000 health professionals every year in the VA system . We are the largest
trainers you said of doctors , nurses, physical therapist s, pharmacist , social workers , if it
was not for the VA Healthcare System ther e would not be the supply of healthcare
professionals for the rest of America . 70% of US physician medical students go through
the VA during further training , I know in my training I went through three VA medical
centers . As you mention ed, I do still pra ctice internal medicine practice I practice in the
VA system now , I think it's really important that I stay close to what's happening and I
interact with these trainees and the se students when I practice . Interestingly, I practice
both in person but I als o practice in Grants Pass , Oregon from my office here in
Washington DC overlooking the White House using telemedicine .

Dr. David Shulkin – Chief Executive of the Veterans Administration

Margaret Flinter: Fantastic.

Dr. David Shulkin: And what people don't recognize is VA is very technologically
advanced the largest us er of telemedicine in the country by far and this is another thing
that we expose our trainees to so they come out of the VA system knowing how to use
Electronic Medical Records, knowing how to use Telehealth, knowing how to use these
advanced technologies and they bring that skill to the rest of American medicine .

Mark Masselli: Well I would like to pull at the thread a little on that because you are just
talking about engaging in new delivery systems , the president has a new Precision
Medicine Initiativ e that's out there . Where do you see the role of Precision Medicine,
genomics and the like being rolled out in the Veterans Administration ?

Dr. David Shulkin: Well I think under the president's leadership we have really
embraced this type of medicine as the future of VA healthcare is going how we can do a
better job to treat veterans and all Americans VA has played a central role not only in
Precision Medicine but in the Moonshot efforts which the vice president leads in order to
help find and advance ou r care and curing of patients who have cancer . One of these
other things that makes VA unique is our research , we provide over $1.6 billion a
research every year dedicated specifically to advancing the health of veterans . And we
have the world's largest database of genomic material doing sequencing on the
materials of over 1 million veterans and today have the largest database in the world of
this type of genomic data . And so we a re doing studies to advance cancer care and
care for PTSD and traumatic bra in injury and mental health all in a way that no other
organization in the country is able to do at this point . And so our commitment to
Precision Medicine , our leadership in Precision Medicine we believe is yet another
example of why VA is so critical fo r not only veterans but all of America healthcare .

Margaret Flinter: Well Dr. Shulkin, I think we all in healthcare have benefit ted from that
and also you are working healthcare delivery system redesign , your Patient Care
Aligned Teams so many areas that I think have really been a benefit to everybody in
healthcare so thank you for that. Just one more innovation we would like to check in
with you on the Blue Button initiat ive, the online electronic health portal for veterans ,
what's your research and uti lization and delivery system study showing you in that
arena ?

Dr. David Shulkin: One of the very early innovators of Electronic Medical Records was
VA and 30 years of history now using this , and so what we ha ve been working on is
interoperability of shar ing of information . So VA i s participating in hundreds of these
health information exchanges around the country because our veterans are getting care
both within the system and outside the system . And we ha ve been trying to innovate in
this area , the Blu e Button of course was one of those innovations but we have a whole
team called the US digital team that was actually one of the president's initiatives to
bring people from Silicon Valley and helping us design many of these innovations in a
similar way . W e a re just launching a website called Vets.gov which will be a single
source of information , now you have to go to multiple websites and you have to know

Dr. David Shulkin – Chief Executive of the Veterans Administration

the right numbers to call , but Vets.gov will be the single source where people can
access all informa tion on veteran services . So we continue to try to innovate in this
area .

Mark Masselli: We have been speaking today with the Hon. Dr. David Shulkin
Unde rs ecretary of Health at the US Department of Veterans Affairs , the nation's largest
integrated healt hcare system serving the health needs of almost 9 million US veterans .
You can learn more about their work by going to www.va.gov or you can follow them on
Twitter @V eterans H ealth . Dr. Shulkin , thank you so much for joi ning us on
Conversations on Healthcare.
Dr. David Shulkin: Sure, thank you .

(Music)

Mark Masselli: At Conversations on Healthcare, we want our audience to be truly in the
know when it comes to the facts about healthcare reform and policy. Lori Robert son is
an award - winning journalist and managing editor of FactCheck.org, a nonpartisan,
nonprofit consumer advocate for voters that aim to reduce the level of deception in US
politics. Lori what have you got for us this week?

Lori Robertson: House Minor ity Leader Nancy Pelosi greatly exaggerated in saying “75
percent of the American people get their health benefits through their workplace.”
Around 50 percent of the total population has employer - sponsored insurance. Pelosi
made the 75% claim repeatedly in a conference call in early January and again at a
press conference on Republican ’s plan to repeal the Affordable Care Act.

Democrats have stressed in the past that the ACA isn’t a government - run health care
system but instead it builds upon the work - ba sed insurance system that already existed
in the country , a nd that’s accurate. But Pelosi has claimed that 75% of what she called
the American people get health insurance through their employer isn’t accurate . The
nonpartisan Kaiser Family Foundation est imates that 49 % of the total population had
employer health insurance coverage in 2015. KFF figures are based on the Census
Bureau’s Current Population Survey for March. Separately, the Census Bureau issues
an annual report, the latest of which found tha t 55.7 % of the population had employer -
based insurance for part or all of 2015.

So where did Pelosi get her figure? Her office told us she was referring to the
percentage of working adults, excluding seniors, and that the figure came from a staff
analysi s of the Census Bureau’s report for 2014. The Census figures for that year show
78.8 % of all workers , both full - time and part - time, had private health insurance , Pelosi’s
staff lowered that to 75 % to account for those buying private insurance on the ACA

Dr. David Shulkin – Chief Executive of the Veterans Administration

e xchanges or on the individual market. But there is Census data for this very specific
subset working adults under 65 with employer insurance , 71 % of all workers, age 18 - 64,
who worked part - time or full - time had employment - based coverage in 2014 and in 201 5 .
That’s close to the figure Pelosi used, but it does not represent the percentage of the
American people with employer - based coverage, as she repeatedly said. And that’s my
fact check for this week, I am Lori Robertson Managing Editor of FactCheck.org.

Margaret Flinter: FactCheck.org is committed to factual accuracy from the country's
major political players and is a project of the Annenberg Public Policy Center at the
University of Pennsylvania. If you have a fact, that you would like checked, email us at
www.chcradio.com . We will have FactCheck.org's Lori Robertson check it out for you
here on Conversations on Healthcare.

(Music)

Margaret Flinter: Each week Conversations highlights a bright idea about how t o make
wellness a part of our communities and everyday lives. Cathryn Couch is a self - taught
chef with a love of organic foods and a penchant for helping people in need. After
launching her own meal delivery service in Northern California she often encou ntered a
particular kind of client , someone battling a serious illness who was just too tired or too
sick to prepare nutritious food just when they needed it most .

Cathryn Couch : What happen s when people get diagnosed with a serious health
problem is the ir life becomes very stressful and especially for cancer patient s you also
don't feel like eating and so food at the moment when it needs to be really really
important for many people drop s to the bottom of the priority list . And on the other side
we a re raising a generation of young people that don't know how to prepare food and
don't understand the power that food has in their own life but also for the life of the
community and for the environment .

Margaret Flinter: Co u ch is driven by the idea that foo d is medicine especially for
some body who is suffering the toxic side effects of chemotherapy . When a friend asked
if she would employ her teenage daughter in her kitchen for a summer , she stumbled on
a way to grow her enterprise hire teenage workers , use professional chefs to train them
to cook healthy meals with organic ingredients and place the power of healing with food
into their hands . She launched the Ceres project named after the goddess of
agriculture and fertility she expanded her kitchen facili ties and started h iring dozens of
local teenagers many of whom had never cooked or held a job . And the transformation
in these kids is just amazing .

Dr. David Shulkin – Chief Executive of the Veterans Administration

Cathryn Couch : They walk into a situation where people are being the best of who they
can be, they are i nvited into that , they are given an opportunity to be an owner and to
make a real difference in someone's life . We have this rich resource in our community
of teenagers who are actually longing to be given real opportunit ies to contribute . So it's
a win - win on all those levels and at the same time they are all learning how to cook a
healthy food and they understand that you know when they buy organic carrots instead
of eating process ed chips that they a re actually making the environment better .

Margaret Flinter: Co u ch has since grown her enterprise from her home base in
Sonoma County to Marin County in Northern California and she ha s been contacted by
interested organizations around the country that seek to replicate the program . The
Ceres project earne d Co u ch a CNN's Hero’s a ward , but the real reward she says she
experiences in everyday encounters in the hundreds of teens that she ha s trained and
in the thousands of clients that they have served healthy meals to during the time of
need.

Cathryn Couch : We do a block where clients come in every day and talk about what it
was like to be diagnosed as they have been sick and the difference that the food has
made for them. And it includes sometimes people who know they are terminal , it
includes sometimes pa rtners have lost their partner who com e in and talk about the
difference that the kids made for their partner at the end stage of life and there is a lot of
tears that happen in that room and it's very profound .

Margaret Flinter: A program that train s yo ung people in the art of healthy cooking , using
those skills to feed those suffering from serious illness who might otherwise face
malnutrition , empowering empathy in the kids , helping others to fight illness in the
process , these are all bright ideas .

(M usic)

Margaret Flinter: This is Conversations on Healthcare, I am Margaret Flinter.

Mark Masselli: And I am Mark Masselli, peace and health.

Conversations on Healthcare, broadcast from the campus of WESU at Wesleyan
University, streaming live at www.wesufm.org and brought to you by the Community
Health Center.